| NPI | 1457757858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016041) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36973) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2014-11-12 |